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NICE targets stroke with possible new indicators for GPs and clinical commissioners

NICE – the National Institute for Health and Care Excellence – is consulting on potential new indicators for the NICE indicator menu. Indicators encourage health professionals to assess patients on a range of key health issues where diagnosis and treatment is supported by evidence-based guidelines. The aim is to tackle widespread public health challenges one patient at a time.

Prevention of stroke key focus for draft indicators from NICE

8,000 strokes could be prevented saving the NHS £95 million a year

Estimates suggest 440,000 people do not know they are at risk

The consultation on this set of indicators will run for 4 weeks, closing on 29 February 2016. Anyone with an interest in health, including health professionals, patients, community groups and voluntary organisations, is encouraged to take part. Comments are welcomed via the NICE website and stakeholders are asked to consider issues such as unintended consequences of introducing individual indicators, or any factors that might affect their implementation.

All proposed indicators have been developed using NICE guidance and quality standards. They are reliably based upon robust evidence and designed to support both national indicator frameworks, and drive local quality improvement initiatives.

One area of focus in this year’s consultation is improved identification and management of atrial fibrillation – when a person’s heart beats irregularly, and usually too fast1. The indicators are intended to help prevent stroke – the third biggest cause of death in the UK. Each year in England approximately 110,000 people have a stroke2. In 2009, the cost of stroke in the UK was estimated to be £8.9 billion a year3.

This consultation includes indicators relevant to both general practice and outcome measurement for clinical commissioning groups. Atrial fibrillation (AF) is a contributing factor for 1 in 5 strokes. NHS Improvement estimated that around 8,000 atrial fibrillation related strokes could be prevented if appropriate management was received, which could save the NHS £95 million a year4.

Based on prevalence estimates of AF, up to 440,000 adults with the condition may not be identified4. This population are not receiving appropriate advice and management (such as anticoagulant therapy) to reduce their risk of stroke. Improved identification of AF and timely reviews of anticoagulant therapy are two of the areas NICE has included in the list of proposed indicators.

Professor Gillian Leng, Deputy Chief executive and Health and Social Care Director at NICE, said: “These draft indicators are intended to improve public health one patient at a time. The indicators are a key part of NICE’s drive to save and improve people’s lives, enhance the quality of care in the NHS and use its scarce resources wisely.

“We’d like everyone with an interest in the development of evidence based indicators to tell us their views. Feedback will help us decide which indicators to put forward for publication on the NICE indicator menu.”

Dr Matthew Fay, GP and Specialist Advisor to the Indicator Advisory Committee said: “NICE have highlighted the need to identify people with AF so that we can manage their condition, and therefore prevent stroke from occurring.

“This consultation suggests indicators that will target those who are most likely to have AF; those over 65 and those with an established stroke risk factor.

“Other proposed indicators reinforce the need to support people receiving anti-coagulative treatment for AF. Such as an annual review to ensure their risks of AF-related stroke remains reduced.”

Indicators concerning the management of diabetes are also proposed. These include a range of care processes for children and young people with type 1 diabetes, indicators concerning identification and support of women who may be at increased risk of developing type 2 diabetes after experiencing gestational diabetes.

Dr Andrew Black, GP Mortimer Medical Practice and Deputy Chair of the Indicator Advisory Committee said: “These potential indicators are being developed in a way that would allow them to be used by practices and CCGs for service development and improvement as well as for QOF. In addition they start to look at how whole health systems are responsible for the care of patients.”

Professor Daniel Keenan, Associate Medical Director, Manchester University Hospitals and Chair of the Indicator Advisory Committee, said: “The indicators in this consultation are not final. We will meet as a committee in June 2016to consider all feedback submitted. It is only after this that we will be able to recommend which of these potential indicators should be included in the NICE indicator menu.

“The final menu of indicators, expected to be published on the NICE website in August 2016, will support healthcare professionals to improve the quality of patient care, based on the best available evidence.”

1. Introduced in 2004, the Quality and Outcomes framework (QOF) is an annual incentive scheme that rewards GP practices in the UK for implementing systematic improvements in quality of care for patients. The QOF operates through a points system which rewards GPs for their performance in relation to groups of indicators.

2. NICE took over the arrangements for managing the new process of developing indicators and reviewing the existing indicators in April 2009. It established a new independent Advisory Committee responsible for reviewing existing QOF indicators and recommending new ones before producing a national “menu” of approved indicators which will be made available through the NICE website.

3. Topics prioritised for the 2017/18 QOF by the committee for indicator development were put through a formal indicator development process by the NICE Collaborating Centre for Indicator Development. This process has two elements: piloting in representative practices across England and in a smaller number of practices in Wales, Scotland and Northern Ireland and secondly public consultation.

4. Both the results of piloting and consultation comments will be reviewed by the indicator advisory committee in June 2016 which will then recommend which indicators should be approved for publication by NICE in its annual “menu” of indicators.

5. NICE will publish a proposed list of indicators for 2017/18 QOF, together with recommendations on indicators to be considered for retirement in summer 2016. In England, NHS Employers on behalf of NHS England, and the General Practitioners Committee on behalf of the British Medical Association decide which indicators are included within the QOF. Separate but similar negotiation processes are carried out within Northern Ireland, Scotland and Wales. NICE and the QOF Advisory Committee are not involved in these negotiations. The final QOF indicators for England will be published by NHS Employers.

About CCG OIS

1. The CCG Outcomes Indicator Set (CCG OIS) provides clear, comparative information for CCGs, Health and Wellbeing Boards, local authorities, patients and the public about the quality of health services commissioned by CCGs and the associated health outcomes. The indicators are useful for CCGs and Health and Wellbeing Boards in identifying local priorities for quality improvement and to demonstrate progress that local health systems are making on outcomes. Further information on the CCG OIS is available on NHS England’s website.

2. CCG OIS applies in England only.

3. The results of public consultation and testing by the Health and Social Care Information Centre will be considered by the Indicators Advisory Committee in June 2016.

4. The CCG OIS will also include indicators from the NHS outcomes framework that can be measured at CCG level. NICE is not responsible for the development of these.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

These draft indicators are intended to improve public health one patient at a time. The indicators are a key part of NICE’s drive to save and improve people’s lives, enhance the quality of care in the NHS and use its scarce resources wisely.